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Prostate cancer: treatment options

Prostate cancer is the most commonly diagnosed cancer in men in Australia. If detected early, it can be effectively treated, with many options now available. Here’s what you need to know.

Charmaine YabsleyApril 2018

Prostate cancer occurs when abnormal cells develop in the prostate – the small, walnut-sized gland that sits below the bladder near the rectum.

And although 3,000 men die of prostate cancer in Australia every year, the survival rate has improved significantly in the last 30 years.

Malcolm Freame, chief operating officer of the Prostate Cancer Foundation of Australia (PCFA), says “The 5-year relative survival has improved from 63% in 1989–1993 to 95% in 2009–2013 for men impacted by prostate cancer. Early detection is key for health care professionals to determine the best treatment options.”

Prostate cancer symptoms

As prostate cancer is a slow-growing disease, the majority of men with low-grade prostate cancer can be symptom-free in the early stages.

However, the PCFA recommends looking out for the following symptoms, which may be more noticeable if the disease is at a later stage:

feeling the frequent and sudden need to urinate

finding it difficult to urinate – trouble starting or not being able to urinate, or poor urine flow

discomfort when urinating

finding blood in urine or semen

pain in the lower back, upper thighs or hips.

These symptoms don’t mean you have prostate cancer, but if you do experience any of them, see your doctor.

If you don’t have any symptoms but are over the age of 40 and have a family history of prostate cancer, or you’re over 50, ask your doctor about the pros and cons of a prostate check.

How prostate cancer is diagnosed

When you visit your doctor to check the health of your prostate, they’ll usually do a blood test. This blood test, also known as the prostate specific antigen (PSA) test, shows if there’s an increase in this protein. If your PSA level is high, you’ll need to see a specialist. Not all high PSA levels mean there is cancer, as other health issues, such as a urinary tract infection, can cause a higher-than-normal level.

You’ll also have a prostate examination by your doctor, which involves a gloved, lubricated finger inserted into the rectum to check of the size of the prostate and determine if it’s enlarged, or if there are any abnormalities.

To confirm the presence of cancer, you’ll be referred to a urologist. They may recommend an MRI before proceeding to a more invasive biopsy. You can’t currently claim a Medicare rebate for MRI scans to diagnose, detect and monitor prostate cancer, but recent reports suggest this may change soon.

If a biopsy is needed, your urologist will be guided by an ultrasound as they insert thin, hollow needles through the rectum, or the perineum (the area between the anus and the scrotum), and remove a small sample of tissue from the prostate.

Treatment options

If you’ve been diagnosed with prostate cancer, your health care team will discuss the best treatment options with you. These may include:

Watchful waiting: In some cases, such as older men who may not live longer than 10 years due to age or other health issues, the best option is to continue monitoring symptoms which can be treated as and when they occur.

Active surveillance: If your health care team has determined that your diagnosis is low-risk, you’ll most likely be regularly monitored through ongoing PSA testing, digital rectal examination and biopsy. The advantages of this form of treatment include fewer side effects than other treatments, the fact that your cancer is still closely monitored and if the situation stabilises, further treatment may not be needed.

Prostate removal: A radical prostatectomy, where the prostate is removed through surgery, can successfully stop the disease if it hasn’t spread beyond the prostate gland. The surgeon will remove the entire prostate gland, and some of the tissue surrounding it.

There can be downsides to surgery, which may include long-term impotence, inability to ejaculate, infertility, possibility of incontinence, temporary or permanent difficulty in getting and maintaining an erection, and change in penis size.

Radiation: There are 2 main types of radiotherapy – external beam radiation therapy (EBRT), often used for earlier-stage cancers, and brachytherapy, often used for localised prostate cancer.

After treatment, your prostate may be sore, and you could have difficult or frequent urinating, and possible bowel discomfort. You will be advised to avoid sexual intercourse for a period, and sexual and fertility issues may also be a side effect.

Before beginning treatment, ask your doctor or health care professional for any information or options available to you, including risks, how the procedures are carried out, recovery time, side effects and practical information such as how long you may need to take off work, or need help from others. By gathering all the information, you can then make an informed choice about which is best for your situation.

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